Isolated fracture of the first rib without associated injuries: a case report

Sinha, Sanjib; Mummidi, S K; Londhe, Sanjay Bhalchandra; Campbell, AC

doi:10.1136/emj.18.4.315

Cited by 10 publications

(7 citation statements)

References 4 publications

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“…In addition, the number of patients suffering first rib fractures from isolated low-energy trauma is minimal, with only a handful of reports in the medical literature. 4–6 A more significant omission is the exclusion of prehospital deaths from the TARN database. There was no ready access to the postmortem findings of patients with trauma suffering prehospital demise and no guarantee that first rib fractures would have been either sought or identified at postmortem in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Several reviews mention this association in the context of polytrauma, but the medical literature also includes a number of studies and case reports that describe isolated first rib fractures resulting from relatively minor trauma, without serious complications. 4–6 …”

Section: Introductionmentioning

confidence: 99%

“… 7–9 The other mechanisms of first rib fracture include a strong sudden contraction of the scalenus anterior muscle (considered a low-energy mechanism) and fractures associated with no identifiable mechanical trauma (thought to be stress fractures). 4–6 8 …”

Section: Introductionmentioning

confidence: 99%

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Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database

et al. 2017

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BackgroundFirst rib fractures are considered indicators of increased morbidity and mortality in major trauma. However, this has not been definitively proven. With an increased use of CT and the potential increase in detection of first rib fractures, re-evaluation of these injuries as a marker for life-threatening injuries is warranted.MethodsPatients sustaining rib fractures between January 2012 and December 2013 were investigated using data from the UK Trauma Audit and Research Network. The prevalence of life-threatening injuries was compared in patients with first rib fractures and those with other rib fractures. Multivariate logistic regression was performed to determine the association between first rib fractures, injury severity, polytrauma and mortality.ResultsThere were 1683 patients with first rib fractures and 8369 with fractures of other ribs. Life-threatening intrathoracic and extrathoracic injuries were more likely in patients with first rib fractures. The presence of first rib fractures was a significant predictor of injury severity (Injury Severity Score >15) and polytrauma, independent of mechanism of injury, age and gender with an adjusted OR of 2.64 (95% CI 2.33 to 3.00) and 2.01 (95% CI 1.80 to 2.25), respectively. Risk-adjusted mortality was the same in patients with first rib fractures and those with other rib fractures (adjusted OR 0.97, 95% CI 0.79 to 1.19).ConclusionFirst rib fractures are a marker of life-threatening injuries in major trauma, though they do not independently increase mortality. Management of patients with first rib fractures should focus on identification and treatment of associated life-threatening injuries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database

et al. 2017

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“…Theorized mechanisms of a stress fracture of the first rib consist of the following: (1) external trauma, (2) violent contraction of the muscles attached to the rib, and (3) stress-induced fatigue secondary to repetitive muscle traction. 5,20,21,24 Although the first mechanism is most common in the general population, 26 in the 3 most recent cases reported in baseball, the mechanism of fracture was the secondary fatigue thought to be caused by repetitive muscle contraction.…”

Section: Discussionmentioning

confidence: 99%

First Rib Stress Fractures in Throwing Athletes

Coris

Higgins

2005

Am J Sports Med

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“…Some reviews mention this association in the context of polytrauma; however, the medical literature also includes several studies and case reports that describe isolated first-rib fractures resulting from relatively minor trauma, without serious complications. 8,9 Objectives of the study Until now, there have been no large multicenter studies on the association between first-rib fractures and severe or life-threatening injuries. This study is aimed at shedding light on the significance of first-rib fractures as indicators of serious injury (intra-thoracic and extrathoracic) in polytrauma patientsand their impact on morbidity and mortality in a high-altitude area in Saudi Arabia.…”

mentioning

confidence: 99%

First rib fractures as indicators of serious intra and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality

Al-Mourgi

2019

Int Surg J

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Background: First-rib fractures are relatively rare compared with fractures of other ribs because of the broad structure deeply placed and protected location of the first rib. A high amount of energy is needed to cause a first-rib fracture; violent trauma, such as that involving motor vehicle accident, is a frequent cause of these fractures, as well as other serious intra-thoracic, head, cervical spine, and intra-abdominal injuries. First-rib fractures have traditionally been considered indicators of increased injury severity and mortality in major trauma patients. The aim was to study the significance of first-rib fractures as indicators of serious intra-thoracic and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality in a high-altitude area in Al-Taif, Saudi Arabia.Methods: This is a retrospective study conducted in King Abdul-Aziz Specialist Hospital (KASH), Taif City, KSA. Patients with chest injuries who presented to the emergency department and were admitted to the hospital between November 2013 and March 2016 were included in the study. Data regarding first-rib fracture were collected, and the relationship between first-rib injuries and associated intra-thoracic and extra-thoracic injuries was analyzed.Results: There was a high incidence of first-rib fracture (23.45%), and 35.8% were bilateral. The most common associated chest injury was a pulmonary contusion (58.5%), followed by pneumothorax (32.1%), hemopneumothorax (20.7%), and surgical emphysema (20.7%). The most common associated extra-thoracic injuries in our study were skeletal injuries (47.4%), cervical spine injuries (11.3%), and head trauma (24.5%).Conclusions: Fractures of the first-rib are associated with serious thoracic and extra-thoracic injuries; they are associated only with increased morbidity in patients with polytrauma and have no independent impact on mortality.

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Isolated fracture of the first rib without associated injuries: a case report

Cited by 10 publications

References 4 publications

Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database

Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database

First Rib Stress Fractures in Throwing Athletes

First rib fractures as indicators of serious intra and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality

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